Mustafa ÖZER, Kayhan KESİK, Veysel BAŞBUĞ, Faik TÜRKMEN, Burkay Kutluhan KAÇIRA, İsmail Hakkı KORUCU, Tahsin Sami ÇOLAK, Recep MEMİK

Eklem dışı distal tibia kırıklarının (AO-43A) tedavisinde intramedüller çivi ve minimal invaziv perkütan plak osteosentez uygulamalarının karşılaştırılması

Amaç: Bu çalışmanın amacı eklem uzanımı olmayan distal tibia kırıklarının tedavisinde intramedüller çivi (İMÇ) ve minimal invaziv perkütan plak osteosentez (MİPPO) uygulamaları sonuçlarının karşılaştırılmasıdır.Gereç ve Yöntem: Ocak 2016 ve Nisan 2017 tarihleri arasında eklem uzanımı olmayan distal tibia kırığı nedeniyle İMÇ uygulanan 38 hasta ve MİPPO uygulanan 31 hasta çalışmaya dahil edildi. Ortalama takip süresi 20,12±3,93 aydı. Hastalarda; yaş, cinsiyet, taraf, yaralanma mekanizması, açık kırık varlığı, fibula kırığı varlığı, kaynama oranları, enfeksiyon oranları, Olerud-Molander ayak bileği skoru (OMAS) ve dizilim bozuklukları değerlendirilerek gruplar arasında karşılaştırma yapıldı. Bulgular: İMÇ uygulanan grupta; eşlik eden fibula kırığı oranı %18.4 bulunurken, %7.9 fibula kırığına yönelik plak uygulanmıştı. MİPPO uygulanan grupta ise eşlik eden fibula kırığı oranı %58 hastada bulunurken, %54.8 fibula kırığına yönelik plak uygulanmıştı. Cerrahi sonrası 6. ayda kaynama oranı İMÇ uygulanan grupta % 92,1 olarak bulunurken, MİPPO uygulanan grupta % 90,3 olarak bulundu. Takip OMAS skoru İMÇ uygulanan grupta 85±16.56 olarak bulunurken, MİPPO uygulanan grupta 84.19±17.08 olarak bulundu.Sonuç: Çalışmamız; eklem uzanımı olmayan distal tibia kırıklarında, İMÇ ve MİPPO uygulamalarının birbirine belirgin bir üstünlüğünün olmadığını, her iki tekniğin düşük komplikasyon, yüksek kaynama oranları ve iyi fonksiyonel sonuçlar ile başarılı bir şekilde uygulanabileceğini desteklemektedir.

Anahtar Kelimeler:

Distal tibia kırığı, intramedüller çivi, minimal invaziv perkütan plak osteosentez, kaynama, malunion

Comparison of Intramedullary nailing and minimally invasive percutaneous plate osteosynthesis in the treatment of extra-articular distal tibia fractures (AO-43A)

Purpose: The aim of this study was to compare the results of intramedullary nail (IMN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) applications in the treatment of extra-articular distal tibia fractures.Materials and Methods: Thirty eight patients who underwent IMN and 31 patients who underwent MIPPO for extra-articular distal tibia fracture between January 2016 and April 2017 were included in the study. The mean follow-up period was 20.12 ± 3.93 months. In patients, a comparison was made between groups by evaluating age, sex, side of injury, injury mechanism, presence of open fracture, presence of fibular fracture, union rates, infection rates, Olerud-Molander ankle score (OMAS) and malunion. Results: In the IMN group; the rate of concomitant fibula fracture was 18.4% and a plate was applied to 7.9% of all group. In the MIPPO group, the rate of concomitant fibula fracture was found in 58% of the patients, and a plate application was performed for 54.8% of all group. At the 6th month after surgery, the rate of union was found to be 92.1% in the IMN group, while it was 90.3% in the MIPPO group. The follow-up OMAS score was 85±16.56 in the IMN group and 84.19±17.08 in the MIPPO group.Conclusion: Our study showed that IMN and MIPPO applications do not have a significant superiority to each other in the treatment of extra-articular distal tibia fractures, and both techniques can be successfully applied with low complications, high union rates and good functional results.

Keywords:

Distal tibia fractures, intramedullary nail, minimally invasive percutaneous plate osteosynthesis, union, malunion,

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